DOMINO

Why is this research important?

People with dementia are more likely to fall and break a bone. Osteoporosis is a condition where bones are weaker and break more easily. Broken bones can result in loss of independence, worsening of dementia and need for more support from caregivers.

UK guidelines recommend that people with dementia should be prescribed osteoporosis medicines, where appropriate, to prevent broken bones. However, people with dementia are not often offered these medicines, or do not stay on them long enough for them to be effective. First-line osteoporosis tablet medicines have special instructions on how they should be taken, which can be challenging for people with dementia, and they may be more likely to experience side-effects. Alternatively, osteoporosis medicines can be given by injection or infusion once every 6 months or once a year. This can take place in-hospital, or, in some areas, in the patient’s home.

Why are our aims?

The DOMINO study is a 5-year study (2025 – 2029) to determine the most suitable osteoporosis treatment options for people with dementia, and how healthcare services can be supported to offer these options to more people. The DOMINO study will examine:

1. Prescribing of osteoporosis medicines for people with dementia, including how long people take these medicines, safety, and whether these are different for people without dementia.
2. people with dementia’s experience of deciding about, and receiving different osteoporosis medicines, in different settings
3. cost-effectiveness of non-tablet osteoporosis medicine options for people with dementia
4. NHS barriers to offering non-tablet osteoporosis medicines, at home or in-hospital, to people with dementia.

Then we will:

1. work with patients, carers and clinicians to decide which osteoporosis medicine options are most suitable for people with dementia
2. co-develop resources for patients and clinicians to (1) support medicine decision-making (2) help NHS services to offer people with dementia the best osteoporosis medicine options.

What is our approach?

We will use four approaches, including:

• Analysis of osteoporosis medicines recorded in GP health records
• Interviews with people with dementia, family members, clinicians, and service managers
• Economic evaluation to examine cost-effectiveness of osteoporosis medicine options for people with dementia
• Collaboration with patients, public, and clinical stakeholders to determine the most suitable medicine options and co-develop resources

Want to learn more?

If you want to learn more about the DOMINO study or how you can get involved, contact Laurna on l.bullock@keele.ac.uk

Funding acknowledgment

This study is funded by the National Institute for Health and Care Research (NIHR) [Advanced Fellowship (NIHR304459)/NIHR Academy]